Lake County

Public Health Assessment and Wellness

NASCAR Environmental Health Strike Team Training 2012

State: KY
Type: Model Practice
Year: 2013

ABSTRACT:

In July 2012, Three Rivers Health Department hosted and organized an Environmental Strike Team training/exercise in coordination with a NASCAR Sprint Cup series race at Kentucky Speedway in Sparta, KY. This event, which brings over 120,000 people to a county of 8,000 has over 100 food vendors and dozens of campgrounds associated with it. The public health implications of this event are of great magnitude given the patrons come from all over the country, it is a mass gathering and food preparation and camping occurs on site. The event is considered one of, if not the, largest event in the State of Kentucky according to Governor Steve Beshear. The prevention of food borne illness as well as unsanitary living conditions within the campgrounds that houses tens of thousands was one goal of the operation.

ORGANIZATION:

Three Rivers District Health Department

TITLE:

NASCAR Environmental Health Strike Team Training 2012

In July 2012, Three Rivers Health Department hosted and organized an Environmental Strike Team training/exercise in coordination with a NASCAR Sprint Cup series race at Kentucky Speedway in Sparta, KY. This event, which brings over 120,000 people to a county of 8,000 has over 100 food vendors and dozens of campgrounds associated with it. The public health implications of this event are of great magnitude given the patrons come from all over the country, it is a mass gathering and food preparation and camping occurs on site. The event is considered one of, if not the, largest event in the State of Kentucky according to Governor Steve Beshear. The prevention of food borne illness as well as unsanitary living conditions within the campgrounds that houses tens of thousands was one goal of the operation.
Additionally, the event was to be a training/exercise for the pre-developed Kentucky Environmental Strike teams consisting of members from all over the State. The teams were developed in 2009 but training has been scarce, particularly hands on training of deployment and operating guidelines. With two members of the Strike team on Three Rivers staff, it was noted that more training was necessary. Three Rivers recognized the event as a potential simulated emergency in that staff were required to stay on site in austere living conditions, while faced with high stress and high workload environment in inclement weather conditions. The exercise/training objectives were to develop and finalize standard operating guidelines for deployment, operation and demobilization as well as equipment use while maintaining chain of custody. Additionally, the training was utilized to test new technology that had not been issued, yet was set forth for future emergency deployments. This technology was designed to gather inspection data and produce real time statistics for epidemiological staff and other partners in any event. Three Rivers worked with the Kentucky Department for Public Health's Preparedness Branch as well as Division of Public Health and Safety to secure funding reimbursed from a federal source from a previous deployment of a CDC field officer that was stationed in Kentucky.
This funding was then spent on better developing Kentucky for in state and out of state emergency deployments of Environmental Health Sanitarians that could benefit any number of people within in Kentucky and beyond. When the smoke cleared and the event was over, the 10 man team (two of which were Three Rivers employees AND strike team members) had completed all objectives set forth in the planning. The operating guidelines were completed and finalized including Incident command structure and functionality. The technology was tested and approved and additionally, a web based WEB EOC was utilized to share real-time information from the field for the first time with this team. And lastly, the ultimate goal of adequate coverage, inspections and prevention was upheld with over 400 food inspections completed and dozens of campground inspections protecting the public's health. No public health illnesses or deaths were associated with the event as Sanitarians from 5 different local and state Health Departments worked together for a common goal. Ultimately, it was partnerships with Kentucky Department for Public Health, varying Local Health Departments, Emergency Management and Kentucky Speedway that made the training successful and extraordinarily beneficial for Three Rivers and the state of Kentucky.
The major milestones of this practice fall within the planning and gap recognition early on in the process. These processes were implemented nearly 10 months prior to the actual event and ultimately led to guideline developments, procurement of funding, partnerships, pre-event trainings, and recruitment. Three Rivers is currently working with Kentucky Department for Public Health to maintain sustainability with this training as all subsequent feedback recognized the value of it. We plan to host the event again in 2013 with a new group of Strike Team members and hope to eventually give "on the job" field training to all members on the team.

Responsiveness:
Describe the public health issue that this practice addressesThe public health issues addressed are essentially two-fold: 1. On site real time issues such as food safety and public health nuisance control including sanitation, sewage disposal, drinking water, fire safety, garbage control, vector control and rabies prevention. 2. Future public health issues that are immeasurable in association with emergencies. The better prepared and trained strike team can more adequately and more quickly address public health concerns that arise from a public health emergency. The team trained on Standard Operating Guidelines that were developed due to this practice, as well as equipment available and its use, makes them a more efficient group and Kentucky better prepared as a whole for a timely and organized Environmental Health response/deployment.
The process used to determine the relevancy of the public health issue to the communityA risk based approach was utilized to determine the public health concerns associated with this issue. High numbers of patrons (over 10 times larger than the population in the entire county) brings with it higher risks for public health implications. This event was treated as the highest risk event within the District for the year therefore many resources were put forth to assure a safe environment. Secondly, with Three Rivers having two staff members that are primary team members on the Kentucky Environmental STrike teams, both of whom have been involved in multiple past deployments, it was recognized that procedures and protocols regarding mutual aid emergency response was not securely in place. The teams had been developed following a noted need in 2009 during an ice storm that severely affected over half of the state, however, training of those teams and development of operating procedures, including those dealing with actual deployment, length of deployment, demobilization procedures and actual operation during the event. These processes not only needed better development, but real world testing to assure that they were adequate for the team's needs. Lastly, while much time and money had been spent stocking up equipment for a Kentucky Environmental Strike team deployment, none of the equipment had been actually used or even seen in some cases by the team members. These members, expected to use the equipment in an emergency, needed hands on training and use of the equipment in order to be prepared. This was noted in previous meetings and feedback provided from the group's members.
How the practice addresses the issueThis practice addresses both issues effectively:1. It supplied an additional 8 staff members on site to accompany the 7 supplied by Three Rivers. This doubling of staff assured adequate surveillance and inspections were completed for the duration of the event that would house more people than 3 times that of the entire district.2. The real world event perfectly simulated emergency conditions. Not only did the living conditions, high stress environment, heavy workload, large landmass and risks associated help to give the 'feel' of an emergency, but additionally mother Nature assisted with temperatures of well over 100 degrees simulating uncomfortable environments that have been faced by teams in past deployments. The practice of bringing these Strike team members in for an actual deployment during a simulated emergency proved greatly beneficial to all those involved. Additionally, the team was able to actually work within the Incident command structure, completing appropriate paperwork while utilizing equipment that they were previously unfamiliar with.
Innovation
Evidence based strategies used in developing this practiceNIMS (National Incident Management System) was utilized in the overall operation for overall management of the event. http://www.fema.gov/national-incident-management-system The use of the NIMS system was an accomplished capability of the practice as evident within the After Actions Report. The standard operating guidelines that were developed due to this training were based around the incident command structure.
Process used to determine that the practice is new to the field of public healthIt is unknown if the practice is completely new, however, it is believed to be quite unique. During information gathering for the event, the planning team was unable to find anything similar to the training proposed as they spoke with several other states and jurisdictions regarding pre-developed Strike Teams. Several states were noted as actually having plans with Environmental strike teams listed and detailed, however, none could provide us with information regarding hands on training during an actual event with simulated emergency environment.
How this practice differs from other approaches used to address the public health issueI believe this practice differs from other approaches in that the event was treated as a state wide training program. Kentucky Environmental Strike team members are from a variety of Local health departments as well as Kentucky Department for Public Health. While other states that deal with large NASCAR events may conduct inspections and surveillance for the event, this one was used to address emergency response capabilities for future disasters and trained individuals for those scenarios by developing operating guidelines and protocols during future deployments all while utilizing the actual event as a simulated emergency.

Local Health Department and Community Collaboration StakeholdersKentucky Department for Public Health Three Rivers District Health Department NASCAR Motor Sports Kentucky Speedway Local Health Departments that may receive assistance from Kentucky Environmental Strike teams Gallatin County Emergency Management.LHD RoleOrganization and assurance of fulfillment of public health coverage for the mass gathering event. Additionally, it was the gap recognition in the Kentucky Environmental Strike team guidelines that were noted and the idea for a training pitched to Kentucky Department for Public Health. Ultimately, Three Rivers role in this practice was the idea, the organization, planning, implementation and sustainability.Stakeholder/PartnersKentucky Department for Public Health: Assistance with planning and financial distribution of funds to Local Health Departments involved. Operated State Department Operations Center during event to receive and transmit data to and from the team in the field. Additionally, supplied epidemiological support and equipment necessary for deployment of team. NASCAR Motor Sports: organize and conduct mass gathering event. Kentucky Speedway: provide facilities and grounds for Operations set up as well as appropriate credentials for staff access to grounds. Gallatin County Emergency Management: Assistance to team or patrons in need during the event. Involved in planning of event for organization to assure access for emergency vehicles. Following this event in 2011, Three Rivers visited stakeholders to determine what needs were unmet and what, if anything, we could do to fulfill these needs. One example is a meeting with Emergency Manager, Barry Alexander in September 2011. During that meeting it was discussed that campers were difficult to locate during the event for emergency crews. Three Rivers implemented a numbering and mapping system in 2012 to better assist Emergency vehicles. This procedure numbered all lots and gave maps to our partners. Three Rivers makes all attempts each and every year to strive for improvement in not only our intra-agency procedures but also to work with county partners individually to seek better cooperation and communication for improved response on all agencies. We fully recognize that no one agency can act alone, and the better communication and needs assessments we conduct, the better the overall response.Lessons LearnedWith large events and big money comes the potential for politics. Following the 2011 event, local politicians were hearing feedback from local patrons regarding campground regulations. These regulations are fairly strict and not-so-modern in relation to NASCAR events. During 2011 and up to the event in 2012, Three Rivers worked to change the regulation to include a variance provision for temporary large events. The variance provision would allow for local participation without being forced to expend large sums of money. Unfortunately, without knowledge, local politicians, unaware of Three Rivers' efforts and successes with variance provision implementations into state regulation, made efforts to exempt all temporary event camping from all regulation through statute. When I learned of this new law's implementation set for August 2012, I spoke with the politicians behind it who were unaware of our efforts to resolve past issues and were simply attempting to "do something" to alleviate. The lesson learned is undoubtedly, communicate with political figures as much as you do other stakeholders, as they can change the rules you think you have figured out. While I assumed a regulation revision would be noted by political figures, I did not communicate with them and ultimately wasted efforts.
Implementation Strategy Forming Standard Operating Guidelines: These guidelines were developed and documented following meetings with the planning team and the Environmental Strike Team. The guidelines were drafted and then finalized following teams' approval and then exercised during the event in 2012. Testing of Equipment: While it was known by several Strike Team members that there may be certain equipment available for deployed staff, it was unknown exactly what and how to deploy. Several pieces of equipment were requested, tracked, deployed, used and returned including an RV, off road vehicles, computers and data pens used to gather data. Assure environmental health: With the doubling of staff by bringing the strike team to Sparta, adequate coverage and surveillance was conducted. Over 400 food safety inspections, dozens of campground inspections and countless interactions with the public were completed.Time FrameThe planning for the event including protocol/guidelines development, recruitment and procurement of funds was approximately 9 months. The actual operation during the exercise including deployment, operation and demobilization was 48 hours.
September 2011: needs analysis and discussion with Kentucky Department for public Health the plan.
October 2011: planning begins-development of planning team, first meeting for needs analysis and brainstorming.
November 2011: draft Standard Operating Guidelines and protocols developed.
December 2011: Recruitment of participants
January 2012: Procurement of funds and equipment needs analysis
March 2012: Operations Plan completed and submitted
April 2012: Training of participants on equipment use, protocols and guidelines.
May 2012: development of Incident Action plans, Safety plans, Just in time training programs
June 2012: Alert notification, deployment of team, actual event.
Lessons LearnedIt was learned that while you may request certain "needed" equipment, it may be different or may not be received at all. Specific needs can be requested, but may or may not be fulfilled based on availability. Such was the case in the form of transportation vehicles for our operation. It was necessary to move 10 people around on an extremely large and populated piece of property. 4 seat golf carts were requested for this action and two seat carts with dump beds received. This was not known until the event and alternative means of transportation were secured to assure success of the operation.Cost of ImplementationPlanning meetings and Strike team meetings: funding previously allocated at beginning of budget cycle for Strike Team members. This money is allocated via budget projections prior to the fiscal year and is approximately $20,000 state wide. Equipment, overtime and travel expenses for the event were provided through reimbursed expenses from an overseas deployment of a stationed CDC field officer at Kentucky Department for Public Health. These expenses were allocated to participating agencies and totaled approximately $10,000.

Development of Standard Operating Guidelines for Kentucky Environmental Strike Teams: This objective was met by monthly meetings from September until June 2012 by the 8 member planning committee and concluded with the written documentation utilized in the deployment and for future deployments. The process allowed for coordination of several agencies and shared experiences in the field to create real operating guidelines that had the team member in mind for deployment, operation and demobilization. Through a hotwash that was conducted immediately following the event, the Standard Operating Guidelines received approval from the group. Ultimately upon completion of the event and use of the operating guidelines, there were no changes made based on participant feedback and an improvement plan (attached within After Actions Report)
Testing of Equipment: Equipment tested varied among several items, however most noteworthy were the AdapX data pens used to collect real time data and upload via WebEOC so that inspection activity and results could be monitored by off site Epidemiological staffing. The pens were purchased in 2011 and set aside for emergency deployment however usage of them in an emergency or offsite location had not been attempted. The data was collected by the environmental health staff via writing with the data pens which electronically converted the data into spreadsheets/reports daily. The data was gathered by the Administrative personnel member of the team. Following the use of the pens, it was noted that there were successes in using the equipment, particularly that of real time data organization in a large scale event, but also that there were technological limitations to the equipment based on internet connections and time taken for uploads. (data results are attached to this application)
Fulfillment of Environmental Health Responsibilities: Ultimately the goal in any operation is to protect the health of the patrons. In this practice, not only were there preparedness objectives for future and potential actions needed during an emergency, but also current objectives in protecting the over 100,000 people within the Kentucky Speedway concourse. The inspection data was collected by the Environmental health staff and analyzed/uploaded by the Administrative personnel for Epidemiological analysis. The overall response and operations plans received feedback from those involved and will adjust future plans for a more streamlined performance. Zero cases of any food borne illness or sanitation related illness were reported during or in the weeks to follow the event in relation to any vendor or area associated with the Kentucky Speedway.

Stakeholder commitmentFeedback from participants in the 2012 event was extremely positive and deemed appropriate for all Strike Team members. Following each event, Three Rivers works with Kentucky Department for Public Health in regards to proposal presentation for a training that meets the needs and expectations of the work plan set forth by the Public Health Preparedness Branch.
This has already occurred for the 2013 event. Thus far, Three Rivers has secured support from the Division of Public Health and Safety Director, the Public Health Preparedness Branch training coordinators and the Strike team members. This group recently completed the proposal for the 2013 group to partner for the continued training.SustainabilityUntil all members of the team have had opportunity for this in the field training, Three Rivers will continue to propose and host the training. Resources must be obtained early in the budgeting processes and detailed as a line item for "training". So long as there is a need, and the training continues to meet federal qualifications for funding, it can be funded through Public Health preparedness money. Additionally, Kentucky Speedway has been approached about potentially supplying funding for additional resources for inspections, etc. via the Health Department. An entity funding its own inspections is not unheard of in Kentucky as the State Fair receives similar funding through Department of Tourism.